Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ Acute pancreatitis (AP) is an inflammatory disorder of the pancreas characterized by upper abdominal pain and pancreatic enzyme elevations. Chronic pancreatitis (CP) is a progressive disease characterized by long-standing pancreatic inflammation leading to loss of pancreatic exocrine and endocrine function. +++ ACUTE PANCREATITIS +++ PATHOPHYSIOLOGY ++ Gallstones and alcohol abuse account for most cases in the United States. Diabetes mellitus and autoimmune disorders such as inflammatory bowel disease are also associated with an increase in acute pancreatitis. A cause cannot be identified in some patients (idiopathic pancreatitis). Many medications have been implicated (Table 28–1), but drug-induced acute pancreatitis is considered to be rare. A causal association is difficult to confirm because ethical and practical considerations prevent rechallenge. AP is initiated by premature activation of trypsinogen to trypsin within the pancreas, leading to activation of other digestive enzymes and autodigestion of the gland. Activated pancreatic enzymes within the pancreas and surrounding tissues produce damage and necrosis to pancreatic tissue, surrounding fat, vascular endothelium, and adjacent structures. Lipase damages fat cells, producing noxious substances that cause further pancreatic and peripancreatic injury. Release of cytokines by acinar cells injures those cells and enhances the inflammatory response. Injured acinar cells liberate chemoattractants that attract neutrophils, macrophages, and other cells to the area of inflammation, causing systemic inflammatory response syndrome (SIRS). Vascular damage and ischemia cause release of kinins, which make capillary walls permeable and promote tissue edema. Pancreatic infection may result from increased intestinal permeability and translocation of colonic bacteria. Local complications in severe AP include acute fluid collection, pancreatic necrosis, infection, abscess, pseudocyst formation, and pancreatic ascites. Systemic complications include respiratory failure and cardiovascular, renal, metabolic, hemorrhagic, and CNS abnormalities. ++Table Graphic Jump LocationTABLE 28–1Medications Associated with Acute PancreatitisView Table||Download (.pdf) TABLE 28–1 Medications Associated with Acute Pancreatitis Well-Supported Association Probable Association Possible Association 5-Aminosalicylic acid Acetaminophen Aldesleukin Indinavir Asparaginase Atorvastatin Amiodarone Indomethacin Azathioprine Hydrochlorothiazide Atorvastatin Infliximab Bortezomib Ifosfamide Asparaginase Ketoprofen Carbamazepine Interferon α2b Calcium Ketorolac Cimetidine Maprotiline Ceftriaxone Lipid emulsion Corticosteroids Methyldopa Capecitabine Liraglutide Cisplatin Oxaliplatin Carboplatin Lisinopril Cytarabine Simvastatin Celecoxib Mefenamic acid Didanosine Clozapine Metformin Enalapril Cholestyramine Metolazone Erythromycin Ciprofloxacin Metronidazole Estrogens Clarithromycin Nitrofurantoin Furosemide Clonidine Omeprazole Hydrochlorothiazide Cyclosporine Ondansetron Mercaptopurine Danazol Paclitaxel Mesalamine Diazoxide Pravastatin Octreotide Etanercept Propofol Olsalazine Ethacrynic acid Propoxyphene Opiates Exenatide Rifampin Pentamidine Famciclovir Sertraline Pentavalent antimonials Glyburide Sitagliptin Sulfasalazine Gold therapy Sorafenib Sulfamethoxazole and trimethoprim Granisetron Sulindac Sulindac Ibuprofen Zalcitabine Tamoxifen Imatinib Tetracyclines Valproic acid/salts +++ CLINICAL PRESENTATION ++ Clinical presentation depends on severity of the inflammatory process and whether damage is confined to the pancreas or involves local and systemic complications. The initial presentation ranges from moderate abdominal discomfort to excruciating pain, shock, and respiratory distress. Abdominal pain occurs in 95% of patients and is usually epigastric, often radiating to the upper quadrants or back. Onset is usually sudden, ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.